Employment Application Form

Employment Application

THE CITY OF TRAVERSE CITY ACCEPTS EMPLOYMENT APPLICATIONS ONLY FOR SPECIFIC POSITIONS WHICH ARE OPEN AND SOLICITED. UNSOLICITED APPLICATIONS WILL NOT BE ACCEPTED.
City of Traverse City

Human Resources 400 Boardman Ave Traverse City, MI 49684 (231) 922-4481 citypers@traversecitymi.gov Equal Opportunity Employer
Printable Employment Application
Position applied for:
Announcement No:
Date available to start work

MonthDayYear
Date
Expected Salary:
Name (print)*

First NameLast Name
Date of Application:

MonthDayYear
Date
Home Phone:
Please enter a valid phone number.
Cell Phone:
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com

Education

	Name/Location	Did you graduate	Credit Hours Completed	Degree Received	Major Course of Study
High School
College
Graduate School

Any other educational, vocational or trade school training?
MILITARY SERVICE RECORD
Have you had any experience in the Armed Forces of the United State or in a State National Guard, type Yes or No Above
If yes, Branch
Rank at Discharge
Date of Discharge

MonthDayYear
Date
Special/technical training
Are you in the reserves?
Type Yes or No above
Date obligation ends

MonthDayYear
Date
How were you referred to us?*

Walk-InReferralNewspaper AdFacebookTwitterLinkedInOther (please specify)
References

Please list three (3) references that are familiar with your work life.
Reference
Reference
Reference

EMPLOYMENT EXPERIENCE

(List current or most recent job first. List complete work history, use additional sheets if necessary. Account for periods of unemployment.)
Employer #1
Address
Job Title
Supervisor
Reason for Leaving
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Hourly Rate/Salary-Starting
Hourly Rate/Salary-Final
Work Performed
Employer #2
Address
Job Title
Supervisor
Reason for Leaving
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Hourly Rate/Salary-Starting
Hourly Rate/Salary-Final
Work Performed
Employer #3
Address
Job Title
Supervisor
Reason for Leaving
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Hourly Rate/Salary-Starting
Hourly Rate/Salary-Final
Work Performed
Employer #4
Address
Job Title
Supervisor
Reason for Leaving
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Hourly Rate/Salary-Starting
Hourly Rate/Salary-Final
Work Performed
Employer #5
Address
Job Title
Supervisor
Reason for Leaving
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Hourly Rate/Salary-Starting
Hourly Rate/Salary-Final
Work Performed

ADDITIONAL INFORMATION
Are you 18 years or older?
Type Yes or No above
Are you authorized to work in the United States
Type Yes or No above (if yes, verification will be required)
Have you been previously employed here?
Type Yes or No above
If yes, department & date(s)
List any relatives working here and their relationship to you:
Have you ever been convicted of any violation of law other than traffic offenses?
Type Yes or No above
If yes, where, when and nature of offense(s):
Do you have a valid driver's license?
Type Yes or No above
License No.
Type of License: Operator's (standard driving license) CDL: A, B, or C
Signature
State
Have you had your driver’s license suspended or accumulated more than four points?
Type Yes or No above
If yes, where, when and nature of offense(s):
Have you tested positive, or refused a test within the past two years on any DOT pre-employment drug and/or alcohol test administered by a DOT-covered employer?
Type Yes or No above
Can you perform the essential duties of the job in which you wish to be employed, with or without accommodation?
Type Yes or No above
If no, please explain
State any additional information that you feel may be helpful to us in considering your application.
Resume (Cover letter-if requirement of job posting)

Cancelof
AUTHORIZATION AND UNDERSTANDING
Upon the signing of this application, I represent that all of the information now or hereafter given by me in support of my application is true and
complete. I authorize you to verify any of the information concerning my employment or education with the appropriate individuals, companies,
institutions or agencies, and I authorize them to release such information as you require, including my prior disciplinary employment record,
without any obligation to give me written notice of such disclosure. I also authorize you to release any information requested by any of my
prospective or subsequent employers, including disciplinary employment records. I specifically waive any rights to be notified under Section
6(3)(a) of the Michigan Bullard-Plawecki Act of the release of personnel file information by prior employers and of the release of personnel file
information to prospective employers by the City of Traverse City. I hereby release you and them from any liability whatsoever as a result of any
such inquiries and disclosures. I agree that any false information in support of my application may subject me to discharge at any time during
the period of my employment.

If applying for a position with the City of Traverse City, I understand I may be subject to a full background investigation, including finger print
checks, a review of police and arrest records, and a review of any criminal conviction history. If applying for a position which involves working
with children, I understand that I am subject to a background investigation that will include a review of any criminal conviction history.

I agree that any action or suit against the City arising out of my employment or termination of employment, including but not limited to claims
arising under State or Federal civil rights statutes, must be brought within 180 days of the event giving rise to the claims or be forever barred. I
waive any limitation periods to the contrary. I further agree that if I should bring any action or claim arising out of my employment against the
City in which the City prevails, I will pay to the City any and all costs incurred by the City in defense of said claims or actions, including attorney
fees. I further agree that my employment is conditional until such time as the results of my post-offer employment physical and drug test are
known.

FOR NON-BARGAINING UNIT POSITION APPLICANTS
I understand that neither this document nor any offer of employment constitutes a contract of employment. I agree that either party may
terminate the employment relationship, with or without cause, at any time, and I further agree that this arrangement may only be altered in
writing directed to me personally and signed by the City Manager. I agree that I shall be bound by the rules, policies, regulations, and terms and
conditions of employment of the City as they are from time to time changed, and no additional obligations can be imposed on the City except
that which have been acknowledged in writing by the City Manager.

FOR BARGAINING UNIT POSITION APPLICANTS
I understand that conditions of my employment will be in accordance with the applicable collective bargaining unit agreement with the City of
Traverse City. I agree that I shall be bound by the rules, policies, regulations, and terms of employment of the City as they are from time to time
changed, and no additional obligations can be imposed on the City except those which have been acknowledged in writing by the City Manager.

I further understand that the Michigan Handicappers’ Civil Rights Act, MCL 37.1101, et seq, requires employers to make accommodations to
handicapped applicants and employees where the accommodation does not impose an undue hardship on the employer. Handicapped
employees and applicants may request an accommodation of their handicap by notifying the City in writing of the need for accommodation
within 182 days of the date the handicapper knows or should know that an accommodation is needed. Under the Act, failure to properly notify
the City will preclude any claim that the employer failed to accommodate the handicapper.
Signature

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Employment Application

City of Traverse City

EMPLOYMENT EXPERIENCE

ADDITIONAL INFORMATION